Lower Limb

Question 1

16. Flexion of the hip joint (with the knee extended) is limited by the
A. iliofemoral ligament.
B. anterior abdominal wall.
C. ischiofemoral ligament.
D. pubofemoral ligament.
E. anterior superior iliac spine.
F. None of the above.

Answer 1

F. With the knee joint extended, the hamstring muscles are stretched and limit the degree of flexion of the hip joint.

Question 2

17. Abduction of the hip joint is limited by the
A. pectineus muscle.
B. iliofemoral ligament.
C. ischiofemoral ligament.
D. pubofemoral ligament.
E. ligament of the head of the femur.
F. None of the above.

Answer 2

D

Question 3

18. Extension of the hip joint is limited by the
A. iliofemoral ligament.
B. pubofemoral ligament.
C. ischiofemoral ligament.
D. quadriceps muscle.
E. adductor magnus muscle.

Answer 3

A

Question 4

19. Flexion of the hip joint (with the knee flexed) is limited by the
A. hamstring muscles.
B. iliofemoral ligament.
C. adductor magnus muscle.
D. pubofemoral ligament.
E. anterior abdominal wall.
F. ischiofemoral ligament.

Answer 4

E

Question 5

20. The long head of the biceps femoris muscle is innervated by the
A. obturator nerve.
B. tibial portion of the sciatic nerve.
C. femoral nerve.
D. common peroneal nerve.
E. sural nerve.

Answer 5

B

Question 6

21. The gracilis muscle is innervated by the
A. femoral nerve.
B. common peroneal nerve.
C. sural nerve.
D. obturator nerve.
E. tibial portion of the sciatic nerve.

Answer 6

D

Question 7

22. The gluteus maximus muscle is innervated by the
A. inferior gluteal nerve.
B. nerve to quadratus femoris.
C. obturator nerve.
D. superior gluteal nerve.
E. nerve to obturator internus.

Answer 7

A

Question 8

23. The sartorius muscle is innervated by the
A. obturator nerve.
B. femoral nerve.
C. nerve to vastus medialis.
D. superior gluteal nerve.
E. lateral cutaneous nerve of the thigh.

Answer 8

B

Question 9

24. The hamstring portion of the adductor magnus muscle is innervated by the
A. common peroneal nerve.
B. tibial portion of the sciatic nerve.
C. obturator nerve.
D. femoral nerve.
E. nerve to the pectineus muscle.

Answer 9

B

Question 10

25. The adductor longus muscle is innervated by the
    A. femoral nerve.
    B. common peroneal nerve.
    C. tibial portion of the sciatic nerve.
    D. anterior division of the obturator nerve.
    E. posterior division of the obturator nerve.

Answer 10

D

Question 11

26. A malignant melanoma (cancer) of the skin covering the buttock is likely to spread via lymphatics to the
    A. horizontal group of superficial inguinal nodes.
    B. vertical group of superficial inguinal nodes.
    C. posterior axillary nodes.
    D. popliteal nodes.
    E. internal iliac nodes.

Answer 11

A. Remember that the skin of the back below the level of the iliac crests drains into the horizontal group of superficial inguinal lymph nodes

Question 12

27. Lymph from the nail bed of the big toe drains into the
    A. horizontal group of superficial inguinal nodes.
    B. presacral nodes.
    C. popliteal nodes.
    D. internal iliac nodes
    E. vertical group of superficial inguinal nodes.

Answer 12

E

Question 13

28. The lateral meniscus of the knee joint
    A. has a thick inner border.
    B. is strongly attached around its circumference to
    the tibia.
    C. is more frequently torn than the medial meniscus.
    D. is strongly attached to the lateral collateral
    ligament.
    E. is attached by its anterior horn to the tibia in front
    of the intercondylar eminence.

Answer 13

E

Question 14

29. Lymph from the skin of the lateral side of the foot drains into the
    A. popliteal nodes.
    B. internal iliac nodes.
    C. vertical group of superficial inguinal nodes.
    D. horizontal group of superficial inguinal nodes.
    E. subsartorial nodes.

Answer 14

A

Question 15

30. Lymph from the skin of the medial side of the knee drains into the
    A. popliteal nodes.
    B. vertical group of superficial inguinal nodes.
    C. medial group of the horizontal superficial inguinal
    nodes
    D. internal iliac nodes.
    E. lateral group of horizontal inguinal nodes.

Answer 15

B

Question 16

31. Lymph from the skin around the anus drains into the
    A. internal iliac nodes.
    B. inferior mesenteric nodes.
    C. lateral group of horizontal superficial inguinal
    nodes.
    D. medial group of horizontal superficial inguinal
    nodes.
    E. vertical group of inguinal nodes.

Answer 16

D. Remember that the mucous membrane of the lower half of the anal canal has the same lymphatic drainage as the skin around the anus— namely, into the medial group of horizontal superficial inguinal nodes.

Question 17

32. The sciatic nerve enters the gluteal region through which foramen?
A. Posterior sacral
B. Greater sciatic
C. Anterior sacral
D. Lesser sciatic
E. Obturator

Answer 17

B

Question 18

33. The common peroneal nerve can be palpated in which region of the knee?
    A. As it winds around the medial side of the neck of the fibula.
    B. As it passes around the medial condyle of the tibia.
    C. As it winds around the lateral side of the neck of
    the fibula.
    D. As it passes forward between the tibia and the fibula.
    E. As it crosses the lateral side of the head of the fibula.

Answer 18

C

Question 19

34. If the dorsalis pedis artery is severed just proximal to its medial and lateral tarsal branches, blood can still reach the dorsum of the foot through which vessel(s)?
A. The peroneal artery.
B. The posterior tibial artery.
C. The medial plantar artery.
D. The lateral plantar artery.
E. All of the above.

Answer 19

E

Question 20

35. In children, the chief arterial supply to the head of the femur is derived from which artery or arteries?
    A. The obturator artery.
    B. The internal pudendal artery.
    C. Branches from the medial and lateral circumflex femoral arteries.
    D. The deep circumflex iliac artery.
    E. The superficial circumflex iliac artery.

Answer 20

A. The nutrient artery, which is a branch of the obturator artery, reaches the femoral head in children along the ligament of the head and enters the bone at the fovea capitis. The femoral head is separated from the arteries supplying the neck of the femur by the epiphyseal cartilage.

Question 21

36. Which statement is correct concerning the femoral ring?
    A. It is the opening in the deep fascia of the thigh for the great saphenous vein.
    B. It is the opening in the adductor magnus muscle for the femoral artery.
    C. It is the proximal opening in the femoral canal.
    D. It is the compartment in the femoral sheath for the femoral artery.
    E. It is the compartment in the femoral sheath for the femoral nerve.

Answer 21

C

Question 22

37. To lift the left foot off the ground while walking, which of the following muscles plays an important role?
A. The left gluteus medius muscle
B. The left gluteus maximus muscle
C. The right adductor longus muscle
D. The right gluteus medius muscle
E. None of the above.

Answer 22

D. The right gluteus medius and the right gluteus minimus tilt the pelvis so that the left lower limb is raised, thus permitting the left foot to be advanced forward clear of the ground

Question 23

38. Rupture of the tendo calcaneus results in an inability to do what?
A. Dorsiflex the foot
B. Evert the foot
C. Invert the foot
D. Plantar flex the foot
E. None of the above.

Answer 23

D. The soleus and the gastrocnemius muscles are attached to the calcaneum via the tendo calcaneus. These muscles plantar flex the ankle joint. The plantaris is only a weak plantar flexor muscle.

Question 24

39. A sprained ankle resulting from excessive eversion most likely demonstrates that which structure is torn?
A. The talofibular ligament
B. The tendo calcaneus
C. The deltoid ligament
D. The interosseous ligament
E. The peroneal retinaculum

Answer 24

C

Question 25

``` 40. If the foot is permanently dorsiflexed and everted, which nerve might be injured? A. The deep peroneal nerve B. The superficial peroneal nerve C. The common peroneal nerve D. Thetibialnerve E. The obturator nerve ```

Answer 25

D

Question 26

``` 41. The femoral nerve arises from which of the following segments of the spinal cord? A. L2and3 B. L4and 5and S1, 2, and 3 C. L2, 3, and 4 D. L1and2 E. L5 and S1, 2, and 3 ```

Answer 26

C

Question 27

``` 42. The dermatome present over the lateral side of the foot is which of the following? A. S5 B. L3 C. S1 D. L4 E. L5 ```

Answer 27

C

Question 28

43. The femoral sheath is formed by which of the following layer(s) of fascia? A. The pectineus fascia B. The fascia iliaca and the fascia transversalis C. The fascia lata and the membranous layer of the superficial fascia D. The psoas fascia and the fatty layer of superficial fascia E. The processus vaginalis

Answer 28

B

Question 29

``` 44. Which of the following muscles everts the foot? A. The tibialis posterior muscle B. The flexor hallucis longus muscle C. The peroneus longus muscle D. The tibialis anterior muscle E. The flexor digitorum longus muscle ```

Answer 29

C

Question 30

45. Injury to the common peroneal nerve results in which condition? A. Inability to invert the foot B. Inability to plantar flex the ankle C. Inability to feel skin sensation on the medial side of the leg D. Inability to plantar flex the big toe E. Inability to evert the foot

Answer 30

E. The plantar flexors of the ankle joint and the invertors of the foot are mainly supplied by the tibial nerve. The skin on the medial side of the leg is supplied by the saphenous nerve, which is a branch of the femoral nerve.

Question 31

46. After a lesion of the tibial part of the sciatic nerve, some active flexion may still be possible at the knee joint; the muscles responsible for this remaining flexion include which? A. The short head of the biceps femoris muscle B. The gastrocnemius muscle C. The plantaris muscle D. The popliteus muscle E. The long head of the biceps femoris muscle

Answer 31

A. The short head of the biceps femoris muscle is supplied by the common peroneal nerve.

Question 32

``` 47. A patient in the supine position with the hip and knee joints extended is asked to abduct the lower limb against resistance provided by the physician; this exercise tests which of the following muscles? A. The semitendinosus muscle B. The gluteus medius muscle C. The pectineus muscle D. The gracilis muscle E. The semimembranosus muscle ```

Answer 32

B. The gluteus medius muscle is a strong abductor of the hip joint.

Question 33

48. A femoral hernia has the following characteristics except which? A. It is more common in women than in men. B. The swelling occurs below and lateral to the pubic tubercle. C. It descends through the femoral canal. D. Its neck is related immediately laterally to the femoral artery. E. Its neck is related medially to the sharp edge of the lacunar ligament.

Answer 33

D. The neck of the femoral hernia is related immedi- ately laterally to the femoral vein.

Question 34

49. The gastrocnemius and the soleus muscles have all the following features in common except which? A. They are supplied by the tibial nerve. B. They are found in the posterior compartment of the leg. C. They arise from the femoral condyles and flex the knee joint. D. They insert via the tendo calcaneus. E. They plantar flex the ankle joint.

Answer 34

C. The soleus does not arise from the femoral condyles.

Question 35

50. All the following statements about the sartorius muscle are correct except which? A. It flexes the leg at the knee joint. B. It flexes the thigh at the hip joint. C. It laterally rotates the thigh at the hip joint. D. It adducts the thigh at the hip joint. E. It attaches to the anterior superior iliac spine.

Answer 35

D. The sartorius muscle is an abductor of the hip | joint.

Question 36

51. The following structures are transmitted through the lesser sciatic foramen except which? A. The tendon of the obturator internus muscle B. The internal pudendal vessels C. The nerve to the obturator internus muscle D. The pudendal nerve E. The inferior gluteal artery

Answer 36

E. The inferior gluteal artery emerges from the greater sciatic foramen.

Question 37

52. The following statements regarding the great saphenous vein are correct except which? A. It arises on the dorsum of the foot. B. It enters the leg by passing anterior to the medial malleolus. C. It drains into the femoral vein approximately 1.5 in. (3.8 cm) below and lateral to the pubic tubercle. D. It is accompanied by the saphenous nerve. E. It has no communication with the deep veins of the leg.

Answer 37

E. The great saphenous vein has numerous communications with the deep veins of the leg through the valved perforating veins.

Question 38

53. The following statements regarding the obturator nerve are correct except which? A. It originates from the lumbar plexus. B. It enters the thigh immediately beneath the inguinal ligament. C. It innervates the adductor muscles of the thigh. D. It divides into an anterior and a posterior division. E. It supplies the skin on the medial side of the thigh

Answer 38

B. The obturator nerve enters the thigh through the thigh through the obturator canal

Question 39

After a football injury, an orthopedic surgeon noted that the right tibia of the patient could be moved anteriorly with excessive freedom when the knee was flexed. ``` 54. In this patient, which ligament is most likely to be torn? A. The lateral collateral ligament B. The posterior cruciate ligament C. The anterior cruciate ligament D. The medial collateral ligament E. The patellar ligament ```

Answer 39

C

Question 40

A 69-year-old m an was walking down a flight of steps when he slipped and fell. On impact, his left foot hit the ground and was forcibly inverted and medially rotated. He stated that he felt something give on the lateral side of the dorsum of the foot. Though shocked by the fall and the resulting foot pain, he was able to walk home. Within 2 h, the left foot and ankle had swollen considerably, which made examination by his physician difficult. Movements of the ankle were clearly possible, but inversion was extremely painful. On standing, the patient could bear his body weight without too much discomfort. The physician ordered an anteroposterior and a lateral radiograph of the ankle region, both of which showed nothing abnormal. This patient was diagnosed as having an acute sprain of the lateral ankle. 55. Which ligament is most likely to have been damaged? A. The deltoid ligament B. The anterior talofibular ligament C. The plantar calcaneonavicular ligament D. The anterior ligament of the inferior tibiofibular joint E. The posterior talofibular ligament

Answer 40

B. The anterior talofibular ligament is very commonly damaged, more so than those ligaments on the medial side of the joint. Excessive inversion of the foot with plantar flexion of the ankle or attempted medial rotation of the ankle is the common cause.

Question 41

A 29-year-old woman was involved in an automobile accident. Her car skidded into a tree, and she was thrown forward, striking her right knee on the dashboard. At examination in the emergency department, she was found to have a posterior fracture dislocation of her right hip joint. 56. What bone or bones are likely to have been fractured? A. The greater tuberosity of the femur B. The floor of the acetabulum C. The posterior rim of the acetabulum and fracture of the femoral head D. The lesser trochanter of the femur E. The anterior inferior iliac spine

Answer 41

C. The head of the femur is driven backward by the force of the accident through the posterior rim of the acetabulum that is fractured. The head of the femur may also be fractured.

Question 42

``` 57. What anatomic structure is likely to be compromised in a hip dislocation of this type? A. The tendon of obturator internus B. The sciatic nerve C. The quadratus femoris muscle D. The gluteus maximus muscle E. The superior gluteal nerve ```

Answer 42

B. The sciatic nerve is commonly damaged in this type of fracture dislocation.